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Background To mitigate the psychological burdens of COVID-19 for frontline clinicians (FCs), we adapted an existing evidence-based resiliency program, Stress Management and Resilience Training Relaxation Response Program (SMART-3RP), for FCs. This analysis explores moderators of stress coping to determine which subgroups of FCs benefited most from SMART-3RP. Methods 102 FCs from Mass General Brigham hospitals engaged in the adapted SMART-3RP. Assessments were completed at group entry (Week 0) and completion (Week 4). The primary outcome was stress coping, and we examined 15 possible baseline moderators. We fit linear mixed effects regression models and assessed potential baseline moderators using a likelihood ratio test. We report model-based estimates and confidence intervals for each moderator-by-time interaction (i.e., differential effect), where positive/negative values indicate more/less improvement in average perceived stress coping. Results Stress coping improved from Week 0 to Week 4 (mean improvement [95% CI] = 0.9 [0.6 to 1.2]). FCs with higher anxiety (differential effect [95% CI] = 0.3 [0.1 to 0.4]), depression (0.4 [0.2 to 0.6]), and loneliness (0.4 [0.1 to 0.6]), but lower levels of mindfulness (CAMS-Rfocus: 1.0 [0.4 to 1.6]; CAMS-Raccept: 1.3 [0.7 to 2.0]) and self-compassion (0.4, [0.1 to 0.8]) at baseline experienced greater benefits in perceived stress coping from the SMART-3RP. Baseline health uncertainty along with sociodemographic and work characteristics did not moderate stress coping. Discussion Results highlight particular sub-populations of FCs that may benefit more from a stress management intervention, especially during emergency responses (e.g., COVID-19 pandemic).

Background Physical activity can mitigate the risk of cardiovascular diseases, but the presence of mood disorders makes it challenging to follow or develop a regular exercise habit. We conducted an online comparative effectiveness study (Healthy Hearts Healthy Minds) to evaluate whether an online psychosocial intervention adjunctive to an activity monitor (Fitbit) can improve adherence to physical activity among individuals with mood disorders who have or are at-risk for cardiovascular disease (CVD). Methods In this paper, we explore design considerations (including both procedural challenges and achievements) of relevance to our study. Results Challenges of this study included navigating a complex IRB review process, integrating two study platforms, automating study procedures, and optimizing participant engagement. Achievements of this study included building trust with collaborators, leveraging existing online communities, generating daily data reports, and conducting patient-centered research. Limitations These design considerations are based on a single online comparative effectiveness study, and other online intervention studies may be presented with other unique challenges that are specific to their study format or aims. Consistent with some of the generalizability challenges facing other online studies, participants in this study were overall highly educated (most had at least a college degree). Conclusions We successfully conducted a large-scale virtual online intervention to increase physical activity of participants with comorbid mood and cardiovascular disorders by overcoming substantial operational and technical challenges. We hope that this exploration of design considerations in the context of our online study can inform upcoming online intervention studies.

Depressed individuals are more likely to die from cardiovascular disease (CVD) than those without depression. People with CVD have higher rates of depression than those without and have higher mortality rates if they have comorbid depression. While physical activity (PA) improves both, few people engage in enough. We compared self-guided internet-based cognitive behavior therapy (CBT) + Fitbit or mindfulness-based cognitive therapy (MBCT) + Fitbit, with Fitbit only to increase daily steps for participants with depression who have low PA.Adult participants (N = 340) were recruited from two online patient-powered research networks and randomized to one of three study interventions for 8 weeks with an additional 8 weeks of follow-up. Using linear mixed effects models, we evaluated the effect of the intervention on average daily steps (NCT03373110).Average daily steps increased 2.8 steps per day in MBCT+Fitbit, 2.9 steps/day in CBT + Fitbit, but decreased 8.2 steps/day in Fitbit Only. These changes were not statistically different between the MBCT+Fitbit and CBT + Fitbit groups, but were different from Fitbit Only across the initial 8-week period. Group differences were not maintained across follow-up. Exploratory analyses identified comorbid anxiety disorders, self-reported PA, and employment status as moderators.Changes in daily steps over both 8- and 16-week periods-regardless of intervention group-were minimal. The results emphasize the limits of using self-guided web-based psychotherapy with an activity tracker to increase PA in participants with a history of depression and low PA.

Prior work demonstrates a relationship between suicidal behavior and mood disorders, as well as between suicidal behavior and cardiovascular risk. When cardiovascular risk and mood disorders co-occur, people with these comorbid conditions tend to experience worse outcomes than people with only one of these conditions. As such, given the relevance of suicidal thoughts and behaviors among those with cardiovascular risk and mood disorders, suicidal thoughts and behaviors may be of particular concern in the comorbid population. However, the factors that differentiate those with or without suicidal thoughts or behaviors are unknown. Self-reported well-being is one factor that is shown to hold a relationship with suicidal risk, and may be relevant in the comorbid population. Thus, we evaluated whether different levels of well-being relate to suicidal thoughts and behaviors among individuals (N = 340) with lifetime mood disorders and cardiovascular risk who participated in a 16-week online exercise study. Participants completed self-report assessments of lifetime (per the MINI International Neuropsychiatric Interview) and current (per the Patient Health Questionnaire-9) suicidal thoughts and behaviors, as well as a self-report assessment of well-being (per the WHO-5 Well-Being Index). We found that individuals with lifetime and current suicidal thinking had lower total WHO-5 scores over the study period. These data suggest that, among those with a history of depression and who have or are at-risk for cardiovascular disease, the risk of current or lifetime suicidal thoughts and behaviors may be increased for those who experience decreased well-being.

Prior studies suggest that individuals may respond inconsistently to different assessments of suicide attempt (SA) history; yet, little is known regarding why inconsistent reporting of SA history may occur. The overarching goal of this study was to examine individuals' self-reported reasons for inconsistently responding to different self-report measures designed to assess SA history.Young adults who reported a lifetime history of suicidal ideation (Of the sample, 75% of participants denied an SA history across all three measures, 16% reported an SA history across all measures ("consistent responders"), and 9% responded inconsistently to SA history measures ("inconsistent responders"). Of the 9% (Findings from this study underscore a need for increased efforts to improve SA history assessments.HIGHLIGHTSSome individuals may provide inconsistent responses across different suicide attempt measures.Confusion about the definition of a "suicide attempt" may lead to inconsistent responding.Further research is needed to improve our assessment of suicide attempt history.

Study Objectives:Prior cross-sectional studies indicate that psychological factors (eg, perceived burdensomeness, thwarted belongingness) may explain the relationship between insomnia and suicidal ...